Allison brought up a great point in a comment on my last post: when it comes to choices related to reproductive health, why not err on the side of caution?

The most obvious answer is that we should not settle for error if finding the correct answer is an option. But certainty is hard to find in this world, and I believe in the primacy of the well-formed conscience. So, when one is deciding for oneself, it is perfectly appropriate to subject oneself to a tough standard in order to be cautious.

There is, however, a world of difference between choosing to “be cautious” in one’s own life, and holding up the same standard as a universal obligation.

I believe that everyone should make a point of getting adequate vitamins and minerals (preferably from the perfect diet, of course) and that almost all sexually active women should take prenatal vitamins during their reproductive years. Half of all pregnancies in the United States are unplanned, and folic acid, for instance, is crucial before most women even know that they are pregnant. I am not concerned as much about folic acid for myself since I get a lot of folate in my diet, but as a vegetarian I do have to watch out for some other B vitamins (B12 in particular) and iron for my own health. Supplements are not as good as a perfect diet, and may be a complete waste for some women, but most people are lazy, and taking a multivitamin is the least they can do to prepare for a healthy pregnancy, even if they are not planning on pregnancy.

That seems pretty reasonable to me, but there is so much more that all women could do, if we really wanted to err on the side of caution. Somehow though, I cannot expect all women to have all amalgam fillings removed months prior to conception, stop wearing makeup, coloring their hair, using traditional cleaning products, maintain exactly the ideal weight as well as ideal cardio fitness, stop eating all refined flours and sugars, chemical additives, or non-organic meat or dairy, and insure that their husbands complete a full detox and vitamin regimen months before ever having sex. I might do all of those things myself, but it is not a reasonable universal expectation because it is not only likely unnecessary, it is also inconvenient.

And if I could not tell other women to stop eating fast food while pregnant because it is inconvenient, how much less could I tell another woman suffering from endometriosis that she may not take artificial hormones when she is in significant pain?

There is yet another problem with the desire to “err on the side of caution” when it comes to women’s1 reproductive health: sometimes being “cautious” may actually be harmful.

A pregnant woman who has the flu may decide that her baby is more important than her discomfort, so she refuses to take anything to ease her symptoms. She then goes for days with a fever and vomiting, exposing her baby to both the risks of fever and dehydration.

Or perhaps another healthy woman reasons that she should not exercise during pregnancy because doctors frequently instruct women not to exercise if they are at risk for miscarriage. Better extra safe than sorry, right? So the pregnant woman gains unnecessary weight, her obstetrician may freak out about fetal macrosomia and require a cesarean, and “erring on the side of caution” unnecessarily caused respiratory issues for the baby.

And what about the woman with severe pain from endometriosis? If we urge her to “err on the side of caution” and not take hormonal birth control, what is the most likely alternative? Often her doctor will suggest high doses of NSAIDs. If the woman has pain daily, she is likely to take painkiller every day. If her pain is only associated with menstruation, then she will be instructed to begin taking the NSAIDs prior to the point when her pain typically starts. In either case, she is more likely to become pregnant than a woman on the pill, and would be taking the medication prior to knowing that she was pregnant. With the pill there is only conjecture about miscarriage, and currently little fear about birth defects. With NSAIDs there are studies linking the drug to increased rate of miscarriage and birth defects. So it is possible that in urging women to “err on the side of caution” we may actually be urging them to try an alternative which is actually more likely to result in miscarriage or birth defect.

We must all weigh relative risks and research our options for ourselves. At the moment I cannot see how “erring on the side of caution” can be good universal advice when it comes to reproductive health.

1. And it is always women’s reproductive health that we’re concerned about, isn’t it? It does not matter if there is evidence that abnormal sperm morphology can cause miscarriage. No one is going to worry ask whether your 40+ overweight husband is causing miscarriage or suggest that he should not take his blood pressure medication because it is an abortifacient. So a woman may only take the pill for pain if a couple is willing to live with complete abstinence, but there is no problem with a couple having sex while the man continues to work at a place which exposes him to toxins which we know impact sperm quality which we know is correlated with repeated miscarriage?

8 thoughts on “Sex, Drugs, and Pain Control”

Well put – I refused to take the pill before I was married as a way of managing my severe endometriosis pain because I hated what it represented and because every Catholic I spoke to said not to – they said the hormones in the pill were poison.

Now I think it would have been better if I had. After two years of marriage, we haven’t had kids and I’m due to have lapro for the endo next month. The hormones from the pill would have limited the spread of the endo and it wouldn’t have been contraceptive or abortive because I wasn’t sexually active. It’s too late now. We’re pushing ahead with adoption – and I can’t wait!

There is actually no solid evidence that I am aware of that taking the pill to manage endo limits it’s spread. It can help with pain management, sure, but the endo continues to spread while a woman is on the pill. Hormonal contraception is not a real “treatment” for endo. It doesn’t make it go away–the only way to make it go away is surgery. (Ideally a surgery performed by a well-trained physician in surgical Naprotechnology, which has a much lower rate of adhesions following surgery than conventional methods).

In fact, surgery may be just the thing for you, Mrs. C. I had my lap in April, had stage I endo removed, and conceived in August. Good luck…

Can you cite studies that show that endo spreads just as much while ovulation is suppressed? I do not disbelieve you, and I am quite aware that doctors get things wrong all the time, but since I have heard from experts that this is the case, I can’t believe that it is not the case without seeing something more.

I think I see where you were going with your argument against “erring on the side of caution,” Rae, but I’m not sure that what you’re saying falls into the primacy of conscience. To me, the important, pivotal factor in each of the scenarios you’ve presented is the need for reasoned, informed judgment, that takes into account all moral problems as well as potential costs and benefits. Sometimes–particularly when human life is on the line–”erring on the side of caution” is really the only prudent option.

Because I believe in the importance of following one’s conscience, I believe that it may be right for *me* to not combine sex and artificial hormones because I might *personally* have a standard that differs from that which reason dictates universally. You are free to follow your conscience which tells you to avoid the pill.

But I do not think that a reasoned, informed judgement alone can dictate that sexually active women with endometriosis avoid the pill. My whole point was that you *cannot* “err on the side of caution” in this case. But more on the evidence for that in another post.